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Open Access

Leveraging a health information exchange to examine the accuracy of self-report emergency department utilization data among hospitalized injury survivors

Lauren K Whiteside, Marie C Vrablik, Joan Russo, Eileen M Bulger, Deepika Nehra, Kathleen Moloney, Douglas F Zatzick
DOI: 10.1136/tsaco-2020-000550 Published 28 January 2021
Lauren K Whiteside
1Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Marie C Vrablik
1Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Joan Russo
2Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Eileen M Bulger
3Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
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Deepika Nehra
3Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
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Kathleen Moloney
2Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Douglas F Zatzick
2Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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    Figure 1

    Bland-Altman plot of differences between participants’ self-report and EDIE-documented number of emergency department (ED) visits versus the mean number of ED visits. EDIE, Emergency Department Information Exchange.

Tables

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  • Table 1

    Demographics, mental health and substance use, clinical characteristics and emergency department (ED) visit utilization among trauma patients with elevated risk for mental health and substance use comorbidity (n=169)

    Characteristicn (%)/m (SD)
    Demographics
     Age42.1 (15.9)
     Female96 (56.8)
     Race
      White94 (55.6)
      African-American27 (16.0)
      Native American22 (13.0)
      Asian/Pacific Islander14 (8.3)
      Hispanic12 (7.1)
     Homeless at baseline14 (8.3)
     Public insurance163 (96.4)
    Mental health and substance use
     PCL-C score ≥35 (risk for PTSD)127 (75.1)
     PHQ-9 ≥10 (current moderate depression)155 (91.7)
     PHQ-9 item 9 score ≥1 (current suicidality)41 (24.3)
     AUDIT-C score positive (current alcohol use disorder)83 (49.1)
     History of alcohol use23 (13.6)
     History of major psychiatric illness54 (32.0)
    Clinical characteristics
     Injury Severity Score15.1 (11.3)
     ICU admit96 (56.8)
    Emergency department utilization
     Self-report ED visits in past year1.3 (2.4)
     EDIE ED visits in past year1.5 (2.5)
     EDIE distinct hospitals visited in past year0.69 (0.97)
     Self-report ED visits match EDIE93 (55.0)
     Self-report is less than EDIE (under-reporting)36 (21.3)
     Self-report is more than EDIE (over-reporting)40 (23.6)
    • AUDIT-C, Alcohol Use Disorders Identification Test Consumption; ED, emergency department; EDIE, Emergency Department Information Exchange; ICU, intensive care unit; PCL-C, PTSD CheckList-Civilian version; PHQ-9, Patient Health Questionnaire 9; PTSD, post-traumatic stress disorder.

  • Table 2

    Demographics, clinical characteristics and emergency department (ED) visit utilization reporting patterns (n=169)

    CharacteristicNo ED visits
    n=75
    Matching ED visits
    n=18
    P valueAll matching
    n=93
    Over- reporting
    n=36
    Under- reporting
    n=40
    P valuePost hoc differences
    Demographics
     Age, mean (SD)41.2 (18.0)37.9 (11.3)0.4640.6 (16.9)44.3 (14.9)43.5 (14.2)0.4
     Female, n (%)38 (50.7)14 (77.8)0.0652 (55.9)20 (55.6)24 (60.0)0.98
     Race, n (%)
      White45 (60.0)10 (55.6)55 (59.1)21 (58.3)18 (45.0)
      African-American11 (14.7)3 (16.7)14 (15.1)6 (16.7)7 (17.5)
      Native American5 (6.7)1 (5.6)0.96 (6.5)5 (13.9)11 (27.5)0.08
      Asian/Pacific Islander7 (9.3)3 (16.7)10 (10.8)3 (8.3)1 (2.5)
      Hispanic7 (9.3)1 (5.6)8 (8.6)1 (2.8)3 (7.5)
     Homeless at baseline4 (5.3)0 (0)14 (4.3)1 (2.8)9 (22.5)0.001UR>others
     Public insurance73 (97.3)18 (100)191 (97.8)34 (94.4)38 (95.0)0.36
    Mental health and substance use
     Risk for PTSD, n (%)52 (69.3)14 (77.8)0.5766 (71.0)27 (75.0)34 (85.0)0.23
     Current moderate depression, n (%)67 (89.3)17 (94.4)184 (90.3)35 (97.2)36 (90.0)0.4
     Current suicidality23 (30.7)3 (16.7)0.3826 (28.0)6 (16.7)9 (22.5)0.39
     Current alcohol use disorder34 (45.3)10 (55.6)0.644 (47.3)18 (50.0)21 (52.5)0.85
     History of alcohol use6 (8.0)2 (11.1)0.658 (8.6)5 (13.9)10 (25.0)0.04Match<UR
     History of major psychiatric illness20 (26.7)5 (27.8)125 (26.9)10 (27.8)19 (47.5)0.05Match<UR
    Clinical characteristics
     Injury Severity Score11.1 (17.2)11.4 (12.0)0.0811.2 (16.2)13.0 (15.3)9.6 (12.5)0.23
     ICU admit, n (%)51 (68.0)8 (44.4)0.159 (63.4)20 (55.6)17 (42.5)0.08
    • ICU, intensive care unit; PTSD, post-traumatic stress disorder; UR, under reporting.

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Leveraging a health information exchange to examine the accuracy of self-report emergency department utilization data among hospitalized injury survivors
Lauren K Whiteside, Marie C Vrablik, Joan Russo, Eileen M Bulger, Deepika Nehra, Kathleen Moloney, Douglas F Zatzick
Trauma Surg Acute Care Open Jan 2021, 6 (1) e000550; DOI: 10.1136/tsaco-2020-000550

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Leveraging a health information exchange to examine the accuracy of self-report emergency department utilization data among hospitalized injury survivors
Lauren K Whiteside, Marie C Vrablik, Joan Russo, Eileen M Bulger, Deepika Nehra, Kathleen Moloney, Douglas F Zatzick
Trauma Surg Acute Care Open Jan 2021, 6 (1) e000550; DOI: 10.1136/tsaco-2020-000550
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Leveraging a health information exchange to examine the accuracy of self-report emergency department utilization data among hospitalized injury survivors
Lauren K Whiteside, Marie C Vrablik, Joan Russo, Eileen M Bulger, Deepika Nehra, Kathleen Moloney, Douglas F Zatzick
Trauma Surgery & Acute Care Open Jan 2021, 6 (1) e000550; DOI: 10.1136/tsaco-2020-000550
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